Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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56 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 r E v I E w reconstruction of skin scars (Cross) in treating rolling type acne scars and recommended that type of scars should be kept in mind when choosing between treatment options. Mahmoud et al 1 9 reported a statistically significant improvement in acne scars from baseline following treatment with nonablative fractional laser but improvement was not statistically significant between the 10mJ and 40mJ groups. No difference in incidence of postinflammatory pigmentation was observed among the two groups but pain was significantly higher in 40mJ group. Patients with skin type v and vi reported higher average pain scores than skin type iv patients. Chan et al 20 compared full nonablative fractional resurfacing (NaFr) (3 sessions/8 passes/ 442.5 MtZ/cm 2 ) with mini-NaFr (6 sessions/4 passes/210.5 MtZ/cm 2 ) in asian acne scar patients. there was no difference in clinical efficacy between three sessions of full-NaFr and six sessions of mini-NaFr at the end of follow up; however, the incidence of postinflammatory hyperpigmentation (PiH) was statistically lower in the mini- NaFr group as compared to the full-NaFr group. a recent split- face study performed by alexis et al 2 8 compared the effect of different treatment densities (220MtZ/cm 2 vs 393 MtZs/cm 2 ) on acne scars while keeping the fluence constant at 40mJ. there was no statistically significant difference between different density groups in regards to acne scar improvement and incidence of PiH. a few studies have demonstrated the efficacy of nonablative fractional laser in treating active acne vulgaris in darker skin types. Moneib et al 24 studied the use of fractional lasers as a treatment of active acne vulgaris in 24 patients (sPt ii–v) in a randomized controlled split-face study. each patient received four treatment sessions at two-week intervals and were followed up every three months for a total duration of one year. this study noted a complete clearance of acne during treatment which was maintained during the yearlong follow-up period. Histological analysis was also performed which showed a significant decrease in size of sebaceous glands along with improvement in skin texture and sebum production. another split- face study by Dainichi et al 21 studied the effect of fractional lasers in 12 asian patients and reported a significant improvement in acne and skin tightening effect after two sessions. in conclusion, nonablative fractional laser is an effective modality to treat acne vulgaris (level 1b evidence) and acne scars (level 2b evidence) in skin of color. the risk of developing PiH depends on numerous factors including sPt, laser device, and energy and density settings. However, treatment density is a stronger factor than energy in determining PiH development. More studies and experience are needed to determine the optimum settings to maximize the risk-benefit ratio, especially in skin type v to vi. table 3 (continued): levels of evidence. Evidence and recommendations are based on modified guidelines by oxford center of Evidence based medicine Q U A L I T Y O F S T U D Y C R I T E R I A High-quality prospective right/left comparison trials (prlc): Each patient receives same treatment and c ontrol in split-face body method • Randomization • Placebo controlled • Double blinded (or investigator blinded) • Lack of significant unaccounted drop out subjects • Free of selected reporting • Matched left- and right-sided lesions • +/- follow up low-quality prlc • Lack of high quality controls • Or lack of 2 or more of above criteria • Or inadequacy/obscurity in 3 or more of above criteria

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